Improve RAF Scores With HCC Coding Automation Software

RCxRules automatically reviews 100% of diagnosis codes coming out of your EMR to ensure correct HCC codes are captured. Schedule a 15-minute meeting to learn more.

woman analyzing HCC codes and their effect on RAF scores

HCC Coding Tool to Maximize Value-based Reimbursement

RCxRules helps healthcare organizations improve RAF scores through increased HCC capture/re-capture rates. Our HCC coding automation software increases coder productivity by identifying high-value encounters with HCC coding gaps. This reduces the coding burden on providers allowing them and coders to focus on what they do best—deliver quality care and perform accurate coding.

Integrating with leading EMRs and PM systems, our software ensures initial claims have the most accurate HCC data—every time, guaranteed. 

Supported value-based programs:

 

  • Medicare Advantage Plans
  • Managed Medicaid
  • Accountable Care Organizations (ACOs)
  • Comprehensive Primary Care Plus

Dramatically Increase Productivity and HCC Recapture Rate

300% increase in HCC coder productivity
20% increase in RAF score for returning members
22.5% increase in year-over-year HCC recapture rate

Robust Coding that Reflects Documentation: Efficiently Convert Clinical Notes into HCC Codes

Providers aren’t coders—let them focus on patient care and have coders do what they do best. Your physicians work diligently to treat patients and document their conditions in their clinical notes. Turning this wealth of information into the correct coding requires the specialized skill set of coders. Our automated coding workflow eliminates the need to manually review every claim, enabling HCC coders to work with maximum efficiency.

a doctor trying to capture the correct diagnosis for hcc coding review

Complement your Existing EMR, Revenue Cycle and Population Health Solution with an HCC Coding Tool that Drives Efficiency

The RCxRules engine integrates with your EMR and revenue cycle management systems to verify HCC coding data before claim submission. Correct HCC encounters pass through automatically, while those needing review are sent to your coders to be resolved. We take rich data sets from your existing systems and turn them into actionable insights within the coding workflow to eliminate the need for redundant, retrospective review. Our HCC coding solution workflow consists of:

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Pre-Visit Planning

Whether you rely on RCxRules, or an existing EMR or population health solution, it’s critical to identify your high-risk patients prior to their appointments and to prepare providers ahead of their visits for recapture opportunities.

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Concurrent (Pre-Claim) Coder Review

After the patient visit, RCxRules ensures 100% of encounters are automatically evaluated for diagnosis accuracy and completeness. Then, only those encounters with coding gaps are flagged and routed for coder review before being submitted as a claim.

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HCC Benchmarking

Providers need real-time insights into their coding patterns and documentation accuracy. Timely and relevant data is essential to meaningful physician engagement and measuring the financial impact of your HCC coding team.

Frequently Asked HCC Coding Solution Questions